This study assessed the prevalence of malaria infection and associated factors among pregnant women in Bossaso city, Somalia. This study resulted in a prevalence of 20.9%. In addition to these various potential factors assessed in this study, the factors like the presence of water bond sites around the house and always using ITNs were associated with malaria among pregnant women. However, different studies reported different factors that influence the rate of malaria infection among pregnant women.
The prevalence in this study (20.9%) was much closer to a prevalence of a study done in Benin (20.8%) (Accrombessi et al., 2018). However, this finding is more outstanding from the studies conducted in western Ethiopia (10.2%) (Gontie et al., 2020), Salavan province, Laos (5.9%) (Briand et al., 2016), Burkina Faso (18.1%) (Cisse et al., 2014) Nigeria (3.1%) (Isah, Amanabo, & Ekele, 2011) & in Nigeria as well 7.7% (Agomo, Oyibo, Anorlu, & Agomo, 2009). The reason for this discrepancy might be attributed to the difference in geographical location among the study areas. For instance, our study was conducted in a malaria-endemic area with a high rate of transmission. Therefore, individuals living in malaria-endemic areas have a greater chance of developing asymptomatic malaria. In contrast, those living in low transmission areas have a low probability of being infected, leading to a low prevalence of the diseases in such areas. Another reason for the difference could be methodology, including sampling techniques among these studies.
When this figure is compared with the results from Nigeria (41.6%) (Fana et al., 2015), Zambia 31.8% (Chaponda et al., 2015), the findings were found to be lower. The difference in the prevalence might be due to, study period, study design, and economic differences between the study areas and better implementation of improved malaria interventions, including increased coverage in the distribution of ITNS and IRS in our study area. Based on personal communication of the regional health office, this difference might be due to better availability of ITNs in Bossaso, good health awareness of the community, and expanded health service coverage and utilization in Bossaso.
In this study, Plasmodium falciparum and vivax species caused the majority of the cases, 75.3%, and 22.4%, respectively, while the remaining were caused by mixed infection (2.4%). This result is in line with the 2016 screening survey conducted in the Bossaso regional hospital, which showed 73.7%, 25.4% of malaria infections were caused by Plasmodium falciparum and vivax correspondingly (NMCPs/MoH, 2016). However, our result was lower than the WHO Somalia prevalence reports of the species, which was > 95% of malaria species in the country was due to plasmodium falciparum (WHO, 2010a). On the other hand, the proportion of malaria cases caused by Plasmodium falciparum in our study was lower than the WHO malaria 2018 report, which revealed over 99% of malaria cases in the Africa region were due to Plasmodium falciparum (WHO, 2019b). The possible reason for these variations might be due to marked seasonal, inter-annual, and spatial variability. It may also be due to significant differences in climate (temperature, rainfall, and relative humidity), human settlement, and population movement patterns.
Our study also assessed socio-demographic, obstetric, environmental, and ITN ownership and utilization factors. As a result, the presence of water pond sites around the house or vicinity, how often ITNs being used were significantly associated with malaria.
In this study, always using malaria preventive ITNS significantly associated decreased the odds of developing malaria infection during pregnancy [AOR = 0.1, 95%CI (0.01, 0.88)]. A similar association was found in a study conducted in Lagos, Nigeria (Agomo & Oyibo, 2013). The possible explanation could be due to UNICEF’s recent provision of ITNS and community awareness campaigns by the MOH. The use of ITNs reduces malaria transmission, and it is one of the proven, cost-effective components of malaria prevention through the vector control approach.
In the present study, having water pond sites around the house or vicinity was significantly associated with the occurrence of malaria in pregnant women [AOR = 6.5, 95% CI (1.6, 20.5)]. This finding is in line with a study conducted in Uganda (Musoke et al., 2018) and other studies done in east India, which described it as a potential source of transmission (Sabin et al., 2018). The presence of stagnant water could explain which is an environmental risk factor that increases the breeding of mosquitoes near homes. The relatively inexpensive measures of removing pools of water have been shown to significantly reduce mosquito abundance and malaria incidence. Such interventions can be used with core malaria prevention methods, such as the utilization of ITNs as a strategy to minimize the occurrence of the disease.
Overall, a timely intervention strategy is mandatory and should focus on the WHO recommended three-pronged approach for malaria in pregnancy, which includes ITNS, IPT and case management. In this study, although the majority of the pregnant women had ITNs, yet only a few of them were regularly using it, so the health care providers in the region and stakeholders should create health awareness campaigns on the importance of using ITNs and specifically target pregnant women during routine care visits. In addition to this, a small portion of pregnant women had Sulfadoxine-pyrimethamine during ANC visits. This is also another area that the health care providers should work on since the administration of SP to the pregnant women has already demonstrated significant reductions in the morbidity and mortality of malaria in pregnancy.
Limitation Of the Study
The time of data collection may affect the prevalence due to seasonal variation of malaria transmission. The study did not include a qualitative method, particularly observation of housing conditions. The low prevalence of some of the associated factors created a wide confidence interval reducing the precision of the findings.
This study was conducted in the COVID-19 era, where health systems have become overwhelmed with the efforts required to stop the coronavirus transmission, and hospitals have struggled to cope with increasing numbers of COVID-19 cases. This led to comprehensive concerns about the potential consequences of the pandemic, including disruptions of essential health services including malaria services.